外伤后脑血肿对颅内压分布的力学分析研究

doi:10.13418/j.issn.1001-165x.2019.06.013

中国临床解剖学杂志 ›› 2019, Vol. 37 ›› Issue (6) : 673-679. DOI: 10.13418/j.issn.1001-165x.2019.06.013

临床生物力学

外伤后脑血肿对颅内压分布的力学分析研究

李娜¹，　柳茵¹，　熊鲲²，　宾时珍¹

作者信息 +

Dynamic analysis on distribution of intracranial pressure and herniation risk in patients with traumatic brain injury

LI Na¹， LIU Yin¹， XIONG Kun², BIN Shi-zhen¹

Author information +

文章历史 +

摘要

目的　根据患者CT和颅内压数据，建立外伤性脑损伤的有限元模型，分析脑血肿对颅内压产生的压力响应。方法　采用成人头部有限元模型（GHBMC）与气体分子动力学分析脑血肿膨胀与颅内压增高的关系，提取并折叠血肿，置入有限元模型中相对应的位置，根据CT图像和颅内压值，加入肿胀曲线，进行模拟计算，得到各个部分的脑组织压力分布云图、脑组织应变的分布云图，计算脑疝多发区域的脑组织压力差。结果　有限元模型中的压力值、中线偏离量与临床病人脑室型探头压力、CT图像中线的吻合度较好，误差率分别为4%和2%。模拟结果显示，在左侧颞枕叶矢状位上，左侧基底节区血肿病例大脑镰下方、小脑幕切迹后部压力差不显著，分别为1400 Pa和1320 Pa。但幕上颞叶压力明显大于小脑小叶的压力，分别为2504 Pa和1360 Pa。小脑前叶与后环池的压力无明显差异。左侧脑血肿患者小脑幕比右侧脑血肿患者具有更大的等效应变。结论　左侧患者额颞基底节区的血肿更有可能导致小脑幕切迹疝。而右侧患者的脑血肿导致的压力被小脑幕的应变代偿，脑疝风险因此下降。通过本研究计算脑疝易形成区域的压力差，可更好地理解血肿造成的颅内压分布对激发脑损伤的影响，为损伤的预后提供力学依据。

Abstract

Objective　Finite element (FE) simulation models of two patients with moderate traumatic brain injury who developed hematoma were established according to the patients CT images and the data of intracranial pressure. The effect of intracranial pressure (ICP) caused by hematoma after brain injury was analyzed.　Methods　The finite element simulation models of adult head and molecular dynamics method were used to analyze the relationship between hematoma swelling and increasing of intracranial pressure, to extract and fold the hematoma. The CT images and intracranial pressure values were used to add dilatometry curves, to get the brain tissue pressure distribution map and brain tissue strain map, to calculate the difference of brain tissue pressure on areas which brain herniation happened. 　Results　The pressure values, the clinical mid-line shift displacements of the simulation models were in good fitness with the ventricular probe pressure of clinical patients and the mid-line of CT images, the error rates against the clinical data were 4% and 2% for the two patients. The simulation indicated that, in coronal views of the left temporo-occipital lobe, there was no substantial pressure difference between each side of the gyrus cinguli below the falx, with values of 1400 Pa and 1320 Pa respectively. However, the pressure in the temporal lobe above the tentorium was larger than that in the lobulus quadrangularis cerebelli, with values of 2504 Pa and 1360 Pa respectively. In sagittal views of the left temporo-occipital lobe, there was no substantial pressure difference between the anterior cerebellar lobe and posterior ambient cistern. There was bigger effective strain of tentorium cerebelli of left hematoma patients than that of right side patients.　Conclusions　We conclude that a hematoma in the fronto-temporal and basal ganglia regions of left side patients is most likely to cause anterior transtentorial herniation. The pressure caused by hematoma of right side is replaced by the strain of tentorium cerebelli, thus reducing the herniation risk. This research can make a better understanding of distribution of intracranial pressure caused by hematoma effect on motivation of brain injury, can also provide dynamic reference for injured prognosis.

导出引用

李娜, 柳茵, 熊鲲, 宾时珍. 外伤后脑血肿对颅内压分布的力学分析研究[J]. 中国临床解剖学杂志. 2019, 37(6): 673-679 https://doi.org/10.13418/j.issn.1001-165x.2019.06.013

LI Na, LIU Yin, XIONG Kun, BIN Shi-zhen. Dynamic analysis on distribution of intracranial pressure and herniation risk in patients with traumatic brain injury[J]. Chinese Journal of Clinical Anatomy. 2019, 37(6): 673-679 https://doi.org/10.13418/j.issn.1001-165x.2019.06.013

中图分类号： R322 R45 R493

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